Provider Demographics
NPI:1194019943
Name:DIDOMENICO, MEGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 KINGERY HWY
Mailing Address - Street 2:T1882
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5538
Mailing Address - Country:US
Mailing Address - Phone:630-321-2081
Mailing Address - Fax:630-321-2081
Practice Address - Street 1:7601 KINGERY HWY
Practice Address - Street 2:T1882
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5538
Practice Address - Country:US
Practice Address - Phone:630-321-2081
Practice Address - Fax:630-321-2081
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist